map award journey - departmental collaboration to improve revenue cycle performance
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MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance. Joseph Koons , MSA, FHFMA, CPAM Managing Director, Revenue Cycle. August 1, 2012. Agenda. About Centra Financial Impact DNFB Green Belt Project Review POS Collections Continuous Process Improvement - PowerPoint PPT PresentationTRANSCRIPT
MAP Award Journey - Departmental Collaboration to Improve Revenue Cycle Performance
Joseph Koons, MSA, FHFMA, CPAM Managing Director, Revenue Cycle
August 1, 2012
• About Centra• Financial Impact• DNFB Green Belt Project Review• POS Collections• Continuous Process Improvement• Technology & Other Components
Agenda
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About Centra Health
Available Beds:– Acute 463– Acute Rehab 20– Acute Psych 41– Post Acute 447
Acute Care Hospitals: – Lynchburg General – Virginia Baptist– Southside Community
Payer Mix and Hospital Demographics
Medicare - 50.9%HMO / PPO- 25.3%Medicaid - 14.2%Self Pay -5.8%Commercial -1.9%Other -1.8%
Admission: 26,824ED Visits: 92,212Employees: 5,000+
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• Service Lines:>Home Health>Hospice>Substance Abuse>Mental Health>Child & Adolescent Residential
Treatment>Skilled Nursing>Reference Lab>Rivermont Schools>Cancer Center>Mammography Centers
Revenue Cycle Metrics for CentraGross Revenue: $1,194,866,318
Net Revenue: $ 591,616,570
Gross AR Days: 39
Bad Debt % GR: 1.7%
Charity % GR: 3.7%
DNFB Coding: 4.6 Gross Revenue Days
Inhouse/Unbilled: 2.9 Gross Revenue Days
Cost to collect: 3.0% (HIM, CCD, Pt Access, Pt Accting)
Cash % of NR: 99.7%5
Charity and Bad Debt Trending
3.1% 2.8% 2.5% 2.3% 2.7% 2.9%
4.1%3.3%
3.8%2.8% 3.1%
4.1%
6.4% 6.6%
5.4% 5.5% 5.8%7.0%
6.3%5.8%
7.0%
5.4%
3.6% 3.7%4.2%
2.2%2.1% 1.7%2.8%
3.1%
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%
YTD2002
YTD2003
YTD2004
YTD2005
YTD2006
YTD2007
YTD2008
YTD2009
YTD2010
YTD2011
Charity % GR Bad Debt % GR Total %
• Charity Policy• Payment options• Statements
• Presumptive Charity• Discounts• SP Outsource
Revenue Cycle Structure
• Managing Director of Revenue Cycle with Direct Reports of:– Director, Patient Access - centralized and decentralized in16 locations
• 5 Managers, 2 Financial Counselors• 80.42 FTE’s
– Director, Clinical Coding - centralized and decentralized in 5 locations• 1 Manager• 28.35 FTE’s
– Director, Health Information - centralized in 2 locations• 2 Managers• 56.1 FTE’s
– Director, Patient Accounting - centralized business office• 2 Managers• 45.68 FTE’s
– Director, Revenue Cycle Physician Practices– IT Specialist, RAC Coordinator, and Manager Revenue Integrity
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“Courage is rightly esteemed the first of human qualities
…because it is the quality which guarantees all other.”
Winston Churchill
DNFB PROJECT
DNFB GREEN BELT PROJECT
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Scope of the project focused on inpatient (IAL & IAV) stays
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POINT OF SERVICE COLLECTIONS
Bringing It All TogetherPoint of Service Collections = Financial Counseling
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POSCollections
Local Economy
Training
PaymentPolicy
UninsuredDiscount
SupportPrompt PayDiscount
Payer Mix
CharityProgram
Technology
Incentives
2007 – Before State
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•Inconsistent upfront collections
•No automated payment posting
•Limited pre-registration
•No measurement for accuracy
•Limited insurance verification
•Chargemaster was the only estimation tool
•Estimates contract pricing non existent
•Implemented medical necessity checking and ABN issuance
Continuous Review and Change
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Implement best practice for all work processes across patient access points.Hold staff accountable.
Centra continually trains staff, implemented staff promotion path, and paid testing for certification
Analyze Work ProcessesIdentify Barriers and System Shortfalls
Process Optimization
Communicate with Service Lines
Elevate Staff
continuous process improvement
Director and VP level communication with leaders, educating front line clinical staff
Emphasis should be on any process that continues to be manual – can it be migrated. or does it have system optimization potential.
2008 – The Journey Begins…
• Collections policies and procedures created• Senior Executive and Board approval• Trained staff on collections policies – introduced scripting• Completed implementation of pre-registration unit (call center)• Introduced incentives and tied them to accuracy of registration• Implementation of staff scorecards to include productivity,
accuracy and collections. Posted on departmental webpage• Upgraded existing systems to include integrated payment
posting, separate estimation tool to include contract pricing• Daily progress emails from department Director• Rolled out process in May 2008 – Total collected $753,638
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Staff Training and Communication
• Online policies and procedures• Workflows • Role playing• Scripting• HFMA CBTs• Videos• Daily updates on departmental webpage• Training documents available on departmental webpage• Utilization of tools to enhance workflow, not encumber
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Incentives for Collections
• Annual reset of departmental
goal
• Annual reset of unit goals
• Annual resets of individual goal• Departmental goal adjusted
monthly based on historical data• Individual accuracy goal must be
met for payout for staff
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Incentives for Productivity and Accuracy
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Example:• Jane worked 13 shifts during month• Her average per shift was 58 accounts• Jane’s registration accuracy is 98%• Jane productivity exceed standard by 23 accounts• Productivity bonus = (23 accounts * 13 shifts) * $0.20 = $59.80• Accuracy bonus = (23 accounts * 13 shifts) * $0.10 = $29.90
Productivity is pulled from account transactions, divided by common denominator, and averaged against hours worked to determine accounts managed
It all starts with registration accuracy – REALTIME!
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Sample Daily Error Report
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Sample Scorecards
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Manager Registrar
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Staff in Access work as members of multidisciplinary groups to improve service scores
Departmental KPI’s are published on webpage, open the entire organization
Scores are shared at departmental meetings, service areas and with senior executives
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Tool runs estimates based on insurance plan and contract pricing
Estimates returned include negotiated rates so as to help explain to the patient their final responsibility
2009 Gaining Traction
• Redefined goals, set thresholds based on historical data
• Refined scripting – provided retraining
• Focused on 1st of year deductible & out of pocket
• Added staff to pre-registration unit to increase percentages
• Estimation tool integrated in registration screens
• Refined estimation tool parameters to increase accuracy
• Continued recognition of high performers
• Total collected $1,896,240
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2009 Gaining Traction• Redefined thresholds based on % of net revenue and potential cash
collections• Reviewed collections in service lines and communicated with those
leaders to enhance POS collections activity• Staff training on new financial aid programs• Implementation of prompt pay discounts and payment plans• Implementation of Financial Counseling for inpatient and high dollar
outpatient• Implementation of Financial Counseling software (RevRunner)• Refocus on inpatient accounts and balance after insurance• Centralized staff & implemented collections in mammography
centers • Continued to refine pre-registration practices• Continued daily/weekly recognition of high performers• Total collected $3,418,058
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2011 - Continuous Process Improvement
• Refined reporting tools for management• HFMA’s Map App• Advisory Board – Patient Compass• Horizon Business Insight (HBI) customized drilldowns • Further empowerment of Financial Counselors and Pre-reg
team• Referral workflows reviewed• Continued build for common procedure file in estimation tool
and continued refinement of “lookback” criteria• Revised repayment plans to include >12 months • Revised scripting to emphasize deposits toward service• Continued rule builds in FCW to enhance accuracy
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End of Year 2011 – $5,471,296
Integration is Key
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• Instant notification of approval for credit cards
• Daily reconcilement report from vendor
• Run estimates from workstation• Directly access other tools
• Automated receipts• Ability to post cash, credit
card, e-checks, and other transaction codes as defined
• Ability to post directly from registration screens
What’s Next?
• eSignature for ABN’s• Patient friendly signature pads • Kiosks and Biometric security• Revisit service lines with inconsistent collections• Continued communication to the organization providing
education as to collections program and purpose• Continue comparison to % of net revenue and cash
collections using determination of projected potential in threshold calculation
• Use management tools to further enhance departmental processes, focusing on patient experience
• Consistency, consistency, consistency
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